- St Andrew's Academic Centre
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Northampton
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Research Interests: Nursing, Psychiatry, Mental Health, Mental Health nursing, Risk Management, and 15 moreRisk assessment, Medicine, Prospective studies, Humans, Substance Abuse, Predictive Validity, Psychiatric Nursing, Young Adult, Mental health services, Great Britain, Middle Aged, Security Measures, Adult, Nursing Studies, and Risk Assessment
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Accessible SummaryWhat is known on the subject? Risk assessment and risk management are considered to be important practices carried out by mental health nurses. Risk assessment can help keep mental health service users' safe, but... more
Accessible SummaryWhat is known on the subject? Risk assessment and risk management are considered to be important practices carried out by mental health nurses. Risk assessment can help keep mental health service users' safe, but some nurses see it as a ‘tick the box’ exercise. Some studies have looked at nurses' attitudes to risk assessment but no one has systematically described all the studies. What the article adds to existing knowledge? Mental health nurses' attitudes towards risk assessment are diverse with regard to its legitimacy, conduct and value. This study provides an organised framework to help understand the areas in which these different attitudes occur. What are the implications for practice? Since attitudes can influence clinical practice, nurses need to reflect on how they view risk assessment. Further research is required to investigate whether particular attitudes are positive or negative and whether attitudes can be changed. IntroductionUnderstanding nurses' attitudes towards risk assessment could inform education and practice improvements.Aim/QuestionTo explore mental health nurses' attitudes towards risk assessment.MethodAn integrative systematic review (PROSPERO: CRD42023398287). Multiple databases (PubMed, CINAHL, MEDLINE, EMBASE and PsycINFO) were searched for primary studies of mental health nurses' attitudes towards risk assessment. Qualitative studies were subject to inductive coding and thematic analysis; quantitative data were integrated with emerging themes.ResultsEighteen articles were included. Qualitative studies commonly lacked rigorous analyses. Four themes emerged: underlying purpose and legitimacy of risk assessment (philosophical orientation); use of structured approaches (technical orientation); value of intuition (intuitive orientation); and service user involvement (relationships orientation). There were contradictory study findings in each thematic category indicating different attitudes among mental health nurses.DiscussionMental health nurses' attitudes towards risk assessment vary in four key domains. Survey studies suggest they are more approving of structured approaches to risk assessment than many qualitative studies suggest. There is a need to develop a valid measure of attitudes to risk assessment.Implications for PracticeThis review could help health organisations to develop strategies to improve their risk assessment policies and practice. There is a need to develop structured training and education programmes.
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Research Interests: Criminology, Psychology, Psychiatry, Mental Health, Prediction, and 15 moreForecasting, Medicine, Prospective studies, Humans, Aggression, Female, Predictive Validity, Male, Mental Disorders, Mental health services, Middle Aged, Adult, HCR, Predictive value of tests, and Psychiatric Status Rating Scales
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Patient based outcomes tools such as Health of the Nation Outcome Scales can help users and providers to assess whether mental health services promote wellbeing, and can also inform research and clinical audit. With some exceptions,... more
Patient based outcomes tools such as Health of the Nation Outcome Scales can help users and providers to assess whether mental health services promote wellbeing, and can also inform research and clinical audit. With some exceptions, however, completion rates of routine outcomes ratings are poor, and some argue that current tools are not sufficiently service user-oriented. Concurrently, the recovery model as an approach to mental health care, emphasizing concepts such as hope, meaning and sense of self, has come to prominence. The emerging model creates a need to measure whether recovery-led services deliver positive outcomes. To answer this, it is necessary to first ask whether current routine outcomes tools are suitable measures of recovery-related concepts. This article examines the current state of outcomes measurement in UK mental health services in the age of the recovery model and proposes that a twin-track approach is required.
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Introduction Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes... more
Introduction Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with individual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits. This study aimed to identify and critically review research about the effectiveness of interventions for improving social climate in inpatient adult acute mental health settings. Methods Systematic review reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive terms were used to search multiple electronic databases from inception to July 2019. Information about intervention type(s), complexity was extracted and study quality was assessed. Results Twenty-three papers met inclusion criteria of which 20 used a pretest–posttest study design ...
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Accessible SummaryWhat is known on the subject? ‘Leave’ is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods... more
Accessible SummaryWhat is known on the subject? ‘Leave’ is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for example short periods to get off the ward through to extended periods at home prior to discharge. Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective. While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. What the paper adds to existing knowledge? The leave policies of NHS mental health services in England and Wales are highly inconsistent. The extent to which policies are consistent with guidance differs depending on which service is providing care. What are the implications for practice? It is very likely that, because of inconsistencies between services and policies, practice also differs. Clinici...
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Background The Covid-19 pandemic has produced unprecedented challenges across all aspects of health and social care sectors globally. Nurses and healthcare workers in care homes have been particularly impacted due to rapid and dramatic... more
Background The Covid-19 pandemic has produced unprecedented challenges across all aspects of health and social care sectors globally. Nurses and healthcare workers in care homes have been particularly impacted due to rapid and dramatic changes to their job roles, workloads, and working environments, and residents’ multimorbidity. Developed by the World Health Organisation, Psychological First Aid (PFA) is a brief training course delivering social, emotional, supportive, and pragmatic support that can reduce the initial distress after disaster and foster future adaptive functioning. Objectives This review aimed to synthesise findings from studies exploring the usefulness of PFA for the well-being of nursing and residential care home staff. Methods A systematic search was conducted across 15 databases (Social Care Online, Kings Fund Library, Prospero, Dynamed, BMJ Best Practice, SIGN, NICE, Ovid, Proquest, Campbell Library, Clinical Trials, Web of Knowledge, Scopus, Ebsco CINAHL, and ...
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ABSTRACTSelf‐harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general,... more
ABSTRACTSelf‐harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self‐harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self‐cutting management compared with for disturbed behaviours in general using a cross‐sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self‐cutting management. Respondents disapp...
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This is the first of two linked chapters examining the closely related concepts of risk assessment and risk management in secure mental healthcare. In this chapter, we consider the nature of risk in the context of secure mental... more
This is the first of two linked chapters examining the closely related concepts of risk assessment and risk management in secure mental healthcare. In this chapter, we consider the nature of risk in the context of secure mental healthcare, particularly the risk of physical violence but also that of suicide. We provide an overview of the epidemiology of violence and suicide risk in people with mental disorder. Next, we explain how risk assessment has developed over recent decades. We describe unstructured, actuarial and structured professional judgement methods of violence risk assessment, and discuss two of the main tools used in secure clinical practice. Finally, we review the evidence on risk assessment in relation to specialist or minority populations in secure care including women, those diagnosed with intellectual disability, autism spectrum disorder, Black and minority ethnic groups, adolescents and those in neuropsychiatry services. In Chapter 4 we discuss methods of risk management in the secure setting
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This chapter appraises the evidence for nursing in secure mental health environments as a specialty branch of mental health nursing. It opens with a brief history of nursing in secure and forensic mental health settings in England,... more
This chapter appraises the evidence for nursing in secure mental health environments as a specialty branch of mental health nursing. It opens with a brief history of nursing in secure and forensic mental health settings in England, describes the claims made for specialist status and identifies the main definitions and theories of mental health nursing in secure care. The worldwide empirical research evidence about the distinguishing features of the role is reviewed. It is concluded that nursing in secure care requires specialist skills and knowledge related to security, risk, therapeutic activity and clinical specialism. However, nurses working in secure services share many key mental health nursing attributes with those working in mainstream mental health services. Shared characteristics include teamwork, communication and professional development. Core values of both include a recovery and equality focus and commitment to evidence-based practice. Nurses should utilise the best evidence from all settings to support their practice, adapting where necessary to meet the clinical and security needs of the diverse groups for whom they provide care
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Firesetting confers substantial costs on society. In 2010/2011 there were 36 000 deliberately set fires in Great Britain resulting in 72 fatalities and 1700 non-fatal casualties. Around one in five deliberate fires occur in non-dwelling... more
Firesetting confers substantial costs on society. In 2010/2011 there were 36 000 deliberately set fires in Great Britain resulting in 72 fatalities and 1700 non-fatal casualties. Around one in five deliberate fires occur in non-dwelling buildings, including hospitals (Department for Communities and Local Government, 2011). While serious fires in psychiatric hospitals are reasonably rare, incidents in UK secure mental health units in recent years, at Stockton Hall in North Yorkshire in 2010 (BBC News, 2010) and Camlet Lodge in London in 2008 (James, 2008), have demonstrated that fire can seriously disrupt service provision and endanger life. Additionally, the total number of incidents in psychiatric hospitals attended by the fire and rescue service is disproportionately greater per bed than in general medical hospitals (Grice, 2012). Around 10% of people admitted to forensic psychiatric services have committed arson (Coid et al, 2001) and many more may have a history of problematic firesetting behaviour (Geller et al, 1992). It is important therefore that staff who work in these services hold sufficient practical and theoretical knowledge to contribute to the prevention of firesetting and to the assessment, treatment and management of firesetters in secure care
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Background: Happiness is a positive feeling that is vital and significant to maintain health. Nurses are working in difficult conditions which may heavily affect their level of happiness and ability to provide care. Job burnout is a... more
Background: Happiness is a positive feeling that is vital and significant to maintain health. Nurses are working in difficult conditions which may heavily affect their level of happiness and ability to provide care. Job burnout is a mental reaction against some persistent source of workplace stress. The purpose of this study was to identify happiness and its relationship with job burnout in nurses working at Tabriz’s educational hospitals. Methods: This descriptive-correlational study was conducted on 344 nurses working at Tabriz’s hospitals in 2018. The subjects were selected by means of proportionate stratified random sampling. Data were collected using three questionnaires (demographic information, job burnout with 22 items and three subscales and Oxford happiness with 29 items) and analyzed in SPSS version16 using descriptive statistics. Statistical tests such as Pearson correlation coefficient, independent t-test, one-way ANOVA, and multiple linear regression analysis were used...
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Aims and objectiveTo capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer.BackgroundImproving the physical health care of consumers with mental illness has been widely adopted as a priority... more
Aims and objectiveTo capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer.BackgroundImproving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting.MethodAn exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward‐based nurses (n = 64) and nurse unit managers (n = 8). Th...
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Research Interests: Nursing, Mental Health, Mental Health nursing, Clinical Pharmacology, Medicine, and 15 moreAttendance, Drugs, Humans, Advanced Nursing Practice, Judgment, Great Britain, Middle Aged, Professional Practice, Professional Autonomy, Adult, Clinical Competence, Medication Errors, Mental Competency, Pharmaceutical preparations, and interprofessional relations
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Aims Psychological First Aid is a brief intervention based on international guidance from the World Health Organisation. Free to access online training in the intervention was introduced during the COVID-19 pandemic in UK. We aimed to... more
Aims Psychological First Aid is a brief intervention based on international guidance from the World Health Organisation. Free to access online training in the intervention was introduced during the COVID-19 pandemic in UK. We aimed to determine the uptake of Psychological First Aid training among healthcare workers in care homes in the UK and to assess its effects on their wellbeing. Design This was a sequential mixed methods design. Methods Healthcare workers (nurses and carers) working in care homes in the UK were surveyed about their uptake of Psychological First Aid, their stress, coping efficacy and the key concepts of Psychological First Aid (safety, calmness, hopefulness, connectedness, and accomplishment). Those that completed the Psychological First Aid training were asked to share their experiences via qualitative survey. Data collection was conducted between June and October 2021. Analyses included descriptive statistics and regression analysis. A six step thematic analys...
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Research Interests: Psychology and Rc
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Little is known about the experiences of male patients in secure mental health and intellectual disability units during environmental transition. We interviewed patients before (n = 9) and after (n = 8) a side-to-side security transition... more
Little is known about the experiences of male patients in secure mental health and intellectual disability units during environmental transition. We interviewed patients before (n = 9) and after (n = 8) a side-to-side security transition from medium-secure wards in an older building to new wards in a purpose-built building. We inquired about transitional experiences in general and about this transition specifically. We examined interview transcripts and field notes using thematic analysis, and collated routine outcome data to gauge whether transition had obvious positive or negative effects. Qualitative analysis indicated three major themes (information, transition, and behaviour) and five overlapping subthemes (positive information sharing and consultation, concerns and anxieties about lack of information, life change and opportunity, home and sense of belonging, and potential conflict). Outcome data indicated little obvious change between first and second interviews. Expressed con...
Research Interests: Psychology, Nursing, Mental Health nursing, Intellectual Disability, Medicine, and 14 moreEngland, Thematic Analysis, Accommodation, Humans, Male, Mental Disorders, Social Environment, Middle Aged, Security Measures, Adult, Public health systems and services research, Environment Design, Psychiatric Hospitals, and Patient transfer
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Research Interests: Psychology, Rehabilitation, Psychometrics, Neurorehabilitation, Medicine, and 15 moreBrain, Humans, Aggressiveness, Aggression, Behavior Therapy, Female, Male, Middle Aged, Questionnaires, Adult, Observational Study, Psychiatric Mental Health Nursing, Brain injuries, Psychology and Cognitive Sciences, and Medical and Health Sciences
People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of individual patient groups.... more
People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of individual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving; were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure; and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.
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The need for accurate local information on the scale, nature and outcome of absconding or Absence Without Leave (AWOL) from an independent UK psychiatric hospital led to this 3-year (1997-1999) retrospective analysis of of AWOL data. One... more
The need for accurate local information on the scale, nature and outcome of absconding or Absence Without Leave (AWOL) from an independent UK psychiatric hospital led to this 3-year (1997-1999) retrospective analysis of of AWOL data. One hundred and forty-eight AWOL incidents involving 88 patients were identified. Absconders were found to be significantly younger, more likely to be detained upon admission and more likely to be unmarried than a control group (n = 1378) of non-absconders. There were no significant differences for sex, length of admission or ethnicity. Descriptive data on the circumstances surrounding AWOL events are given, with at least 24 (16.2%) incidents having serious adverse outcomes. Baseline absconding rates are presented for the specialist clinical divisions within the hospital. There is a need for more detailed studies of absconding by patients within the Adolescent Mental Health Service subgroup where the absconding rate was relatively high and engagement in risk activity whilst AWOL relatively frequent.
Research Interests: Psychiatry, Mental Health, Risk Management, Adolescent, Medicine, and 15 moreHumans, Female, Male, Mental Disorders, Great Britain, Middle Aged, Adult, Ethnic Group, Psychiatric Hospitals, Rc, Treatment Refusal, Rj, Psychiatric Mental Health Nursing, Psychology and Cognitive Sciences, and Medical and Health Sciences
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Nurses' attitudes about the causes and management of aggression affects their... more
Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.
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Research Interests: Psychology, Psychiatry, Education, Assessment, Risk, and 15 moreForensic Mental Health, Risk assessment, FORENSIC, Business and Management, Aggression, Predictive Validity, Hospital, Factors, Clinical Sciences, Predictive, Risk Factors, Risk Assessment, Instrument Design, Prediction Accuracy, and Protective Factor
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Relatively little effort has been made to develop and validate theories that explain firesetting. In this study, the first offense chain model of firesetting in mentally disordered offenders was developed. Twenty-three mentally disordered... more
Relatively little effort has been made to develop and validate theories that explain firesetting. In this study, the first offense chain model of firesetting in mentally disordered offenders was developed. Twenty-three mentally disordered firesetters were interviewed about the affective, cognitive, behavioral, and contextual factors leading up to and surrounding one of their recorded firesetting offenses. Offense account interviews were analyzed using grounded theory. The resulting model consists of four main phases: (a) background, (b) early adulthood, (c) pre-offense period, and (d) offense and post-offense period. The model accounts for firesetting by male and female mentally disordered offenders and highlights the importance of early childhood experiences of fire and the onset of mental illness as precursors to firesetting within this population. Furthermore, the model is able to distinguish between different types of mentally disordered firesetters and their offense styles. The...
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Purpose The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups.... more
Purpose The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups. Design/methodology/approach A cross-sectional survey design of n=45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice. Findings HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, r...